Medical Claims Adjuster
Company: SOS HUMAN CAPITAL SOLUTIONS
Location: Washington
Posted on: April 3, 2026
|
|
|
Job Description:
Job Description Job Description - Analyze medical claims data to
identify trends and potential financial risk across all Medicaid
provider types; - Identifies procedures based on Coding Guidelines
and confirms accuracy and compliance; - Conducts specialized and
focused internal audits of physician and non-physician providers as
well as facility-based care billing practices; - Evaluates the
appropriateness of ICD-10m HCPCS and CPT codes, APC/EAPG, DRG, and
modifier usage, based on medical center policies and related payor
requirements; - Makes determination of overpayments and
underpayments and performs other related analysis and evaluations;
and Assist in developing payment models. - Minimum Qualifications
for Medical Claims Adjuster 5.3.3.1 Associate Degree in Medical
Billing or Medical Coding; - Minimum of three years practical
experience in Medical Billing or Medical Coding; - Knowledge of the
general field and basic principles, concepts, and methodology of
Outpatient and Inpatient Code Sets; - Knowledge and skill
sufficient to use appropriate terminology regarding coding
nomenclature for inpatient and outpatient services; - Knowledge and
skills in Microsoft Excel software application; - Ability to
communicate both orally and in writing in order to communicate with
both in-house staff and external providers; - Knowledge of laws
pertaining to Protected Health Information and the penalties for
unauthorized disclosures; - Strong attention to detail and a
thorough understanding of medical terminology, anatomy, and
physiology are essential; - Minimum of five to ten years coding
experience in a healthcare setting; - Proficiency in EHR software
and other billing systems is required; - Strong analytical and
organizational skills; - Understanding of Alternative Payment
Models (AMPs) and Bundled Payments; - Ability to analyze medical
records and identify coding or billing issues; - Effective
communication skills with providers, stakeholders, - In-depth
knowledge of Healthcare Common procedure Coding System (HCPCS),
CPT, ICD-10-CM and ICD-10-PCS coding systems; - Associate’s or
Bachelor’s degree or Certification in Certified Professional Coder
(CPC), CPCCPB, BCSC, CMRS, Certified Coding Specialist (CCS); -
Certified Coding Specialist (CCS) from AHIMA is preferred -
Excellent communication skills in writing, oral presentations,
public speaking, and computer literacy (Microsoft Word, Outlook,
Excel and Power Point). - Ability to exercise tact, discretion, and
skill in personal relations in dealing with persons at various
levels, and groups, especially in public forum;
Keywords: SOS HUMAN CAPITAL SOLUTIONS, Harrisburg , Medical Claims Adjuster, IT / Software / Systems , Washington, Pennsylvania
